Organization
CANCER WELLNESS HOUSE, INC.
Active
Other names
Survivor Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LIBRETT PHD, MPH (CEO)
(801) 558-5950
Entity
Organization
Contact information
Practice address
59 S 1100 E, SALT LAKE CITY, UT 84102-1508
(801) 236-2294
Mailing address
59 S 1100 E, SALT LAKE CITY, UT 84102-1508
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01
CLINIC/GROUP PRACTICE
—
Enumeration date
04/09/2020
Last updated
04/09/2020
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